Provider Demographics
NPI:1528344975
Name:KWAN, ALEXANDER TAN
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:TAN
Last Name:KWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9229 QUEENS BLVD
Mailing Address - Street 2:APARTMENT 16B
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1056
Mailing Address - Country:US
Mailing Address - Phone:718-505-0580
Mailing Address - Fax:
Practice Address - Street 1:9229 QUEENS BLVD
Practice Address - Street 2:APARTMENT 16B
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1056
Practice Address - Country:US
Practice Address - Phone:718-505-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist